Locked Knee

Locked knee is considered a relative emergency. A disabling condition characterized by the inability to achieve full knee extension. It must be treated quickly and accordingly, as a prolonged locked knee position could lead to contractures complicating a flexion deformity, thus promoting premature cartilage degeneration.

1. KNEE LOCKED Mini Presentation Axler JEAN PAUL, Intern December 2020 Hospital of the State University of Haiti Orthopedics and Traumatology Department

2. Introduction Locked knee is considered a relative emergency. A disabling condition characterized by the inability to achieve full knee extension. It must be treated quickly and accordingly, as a prolonged locked knee position could lead to contractures complicating a flexion deformity, thus promoting premature cartilage degeneration. Axler JEAN PAUL, HUEH 2020 2

3. Objectives Identify the main causes of knee blockage Able to diagnose and manage knee blockage Axler JEAN PAUL, HUEH 2020 3

4. Plan Definition Anatomical reminder Classification Cause Clinic PEC Axler JEAN PAUL, HUEH 2020 4

5. Definition Locked knee is a condition in which the affected person is unable to fully extend the knee. Hussin P, Mawardi M, Nizlan NM. The ' Chalky Culprit ' of acute locked knee . G Chir. 2014 Sep-Oct;35(9-10):239-40. PMID: 25419591; PMCID: PMC4321498. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321498/citedby/ Axler JEAN PAUL, HUEH 2020 5

6. Anatomy of the Knee Axler JEAN PAUL, HUEH 2020 6

7. Anatomy of the Knee Structures providing support and stability: Lateral and medial menisci in disc form. Anterior and posterior cruciate ligaments. Medial and lateral collateral ligaments. Axler JEAN PAUL, HUEH 2020 7

8. Knee Movements Axler JEAN PAUL, HUEH 2020 8

9. Classification Two main categories: True knee Locked : Pseudo- locking of the knee : Axler JEAN PAUL, HUEH 2020 9

10. Causes True locking : A) Meniscus tear : the most common one B) Another cause: a small fragment of bone detaches from the knee joint, known as the loose body . The bone fragment may have become detached from: Knee injury : e.g. patella fracture Underlying knee condition : e.g. knee arthritis or osteochondritis dissecans . Axler JEAN PAUL, HUEH 2020 10

11. Causes Pseudo- locking : is always accompanied by pain causing muscle spasms, keeping the leg in position. The difference is that there is nothing really stuck inside the joint. Axler JEAN PAUL, HUEH 2020 11

12. Cause The most common causes of pseudo locking : Swelling. Inflammation. Patellar Maltracking : a problem with the movement of the patella in front of the knee . Plica syndrome: the synovial plica is a shelf-shaped membrane between the synovium of the patella and the tibiofemoral joint. Knee injury. Axler JEAN PAUL, HUEH 2020 12

13. Clinic Symptoms of the real locked knee chronic knee stiffness. Difficulty to completely straighten the knee. Snapping sensation in the knee. Feel a bump at the site of the loose body. intermittent pain and swelling. The main symptom of pseudo- locked is pain, other: a brief feeling of blockage in the knee a feeling that the knee catches a feeling of slackness or instability in the knee Axler JEAN PAUL, HUEH 2020 13

14. Diagnosis Clinic: Paraclinic: Imaging Ultrasound Scanner MRI Axler JEAN PAUL, HUEH 2020 14

15. Treatment Symptomatic Axler JEAN PAUL, HUEH 2020 15

16. Treatment Knee exercises: to improve knee strength and flexibility. Corticosteroid injections: to reduce knee pain and inflammation Arthroscopic knee surgery: to remove any fragments of cartilage and bone trapped in the knee joint. Axler JEAN PAUL, HUEH 2020 16

17. Conclusion Knee locked is a painful condition that requires immediate management, in order to relieve the patient and avoid complications such as joint degeneration. Axler JEAN PAUL, HUEH 2020 17

18. References Hussin P, Mawardi M, Nizlan NM. The ' Chalky Culprit ' of acute locked knee . G Chir. 2014 Sep-Oct;35(9-10):239-40. PMID: 25419591; PMCID: PMC4321498. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321498/citedby/ https://www.uptodate.com/contents/meniscal-injury-of-the-knee?search=locked%20Knee&sectionRank=1&usage_type=default&anchor=H27376205&source=machineLearning&selectedTitle=1~150&display_rank=1#H27376205 https://www.knee-pain-explained.com/knee-locking.html Bansal P, Deehan DJ, Gregory RJ. Diagnosing the acutely locked knee. Injury. 2002 Jul;33(6):495-8. doi : 10.1016/s0020-1383(02)00081-5. PMID: 12098545. https://pubmed.ncbi.nlm.nih.gov/12098545/ Axler JEAN PAUL, HUEH 2020 18